Long-term follow-up after thoracic radiotherapy: symptomatic heart disease is an ominous sign

Summary Background: Thoracic radiotherapy (RT), es- pecially with past technology, may affect the heart, but rarely leads to symptoms. In pa- tients with symptomatic heart disease after RT, outcome seems to be dismal. Methods: In this observational descriptive study, clinical characteristics, findings of ECG, echocardiography, cardiac interventions and follow-up were analysed in patients with prior RT and symptomatic heart disease. The pa- tients were identified in the echocardiography database during a ten year period. Results: There were 25 patients who had tho- racic RT at a median age of 35 years (range: 9-59) for lymphoma (12 patients), breast can- cer (9) or other cancer (4). At least likely inclu- sion of the heart in the target volume of previ- ous RT was present in of 16 of 20 patients with detailed information on RT. Last follow-up was 24 years (range: 5-57) after RT at a median age of 56 years (range: 30-84). Symptoms (≥1 per patient) included: dyspnea (21 patients), angina (12) and/or heart failure (10). Three pa- tients had prior myocardial infarction. The fol- lowing disease was found: moderate valvular disease in 19 patients (76%), coronary artery disease in 12 (48%), abnormal ECG in 18 (72%), relevant conduction system disease in 9 (36%), restriction / constriction in 7 (28%), and pericardial effusion in 4 (16%). Cardiac sur- gery was necessary in 12 patients (death in 2 patients), percutaneous coronary interven- tions in 5 and pacemaker implantation in 3. Endocarditis occurred in 2 patients. During follow-up (21 ± 8 months), death occurred in 6 patients (24%) and was due to heart disease in 5 of them. Conclusions: If symptomatic heart disease de- velops in the long-term follow-up after RT, complex disease of valves, coronary arteries, conduction system, myocardium and peri- cardium is frequently observed. Cardiac inter- ventions are often necessary; and heart dis- ease may be a common cause of death in these patients. Careful assessment and evaluation of treatment options are needed in this patient group.